670021_INSPECTIONS_20171231

Pr
NUH I H UAHULINA
Department of Environmental Qual

Date of Visit: Arrival Time: Departure Time: 0 : County: Region:
Farm Name: �r�l' � , Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: An' jam{ I Title:
Onsite Representative: RV'V`� '" "' ��V`K-� 1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 10 113 S
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
an to Feeder
Non -Layer
Dairy Calf
eeder to Finish
7W
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
D , P.oultr, C_a aci P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

[Facility Amber:- 'L Date of Ins ection: ipj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;3"No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: i 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FKNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2,No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T-
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes <o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J3"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'P/No
17. Does the facility lack adequate acreage for land application?
❑ Yes O'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ONE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes L No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes :FZKNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Plumber: - 2i Date of Inspection: q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L2 f4o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes oNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes q 'Ea'_NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes PrNo ❑ NA ❑ NE
and report mortality rates that were higher than normal? �"
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes j2rNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 'O"&o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other_ comments.
Use drawings of facility to better exvlain situations (use additional pages as necessary).
I�. Ncua cq� �F c��-k �r��- �� V"ds (COcl Tytv(")
1�W ww is ftuAuk
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Iit
Date: �.
21412015

Type of Visit: t7Coptpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: �� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Via( [ v litcdc—Lc Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
er
Wean to Feeder
ffiN
n-1
Feeder to Finish
Farrow to Wean
Farrow to Feeder
rHNon-L�,
Farrow to Finish
Layers
Gilts
Boars
Other I 1 101 (Other
Latitude:
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Phone:
Certification Number: 11�
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faoili Number: jDate of Insection:
Waste Collection & Treatment
4. I`s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1! Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: [3�'v�1Wmilll LAC ) 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lf L/ 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 7No
0 NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm7�o
threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Zj No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Rf /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
-❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�s
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EfNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Reiauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
io
[] NA
❑ NE
Page 2 of 3
21412015 Continued

lFaoility Number. ZI - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LNo
F
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FA40
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ 'rNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WS10
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
2"No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[2'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 i . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
P�Ko
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Ko
❑ NA ❑ NE
33. Did the Reviewer/Inspector fait to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
WNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
E9 c.aYv V. E E P c� P� 6 F I,.� r"iICC-rt [ATN 5 L
S In rcc .
1P 6-0,W Z 4AS D, q� Xq T o &ID Vf_wALc. �l 105
oV sc46f. cc ��� DDSSN
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
l4 t&C
gootZ
Date:
A wvrl7
IU_
214,1201

Type of Visit: (Z) pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email: C9 W.51
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: /� Title:
Onsite Representative: G��j ly ILICA4 E-LA, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
La er
Wean to Feeder
Non-L
Feeder to Finish
DF,y P,i
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La ers
Gilts
Non-L
Boars
Pullets
Poults
Other I I INI ]Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Phone:
Certification Number: { b )35
Certification Number:
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA []NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
'
ErVNo
❑ NA
❑ NE
Yes
❑ NA
❑ NE
Page I of 3 21412015 Continued

Faclli Number: - Date of Inspection:
Waste Collection & Treatment
4. Iskstorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structured Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA(%25N f Lkc& V LA6mW,
Spillway?:
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any inunediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes U No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes V/o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [3 Yes ❑T o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes I � No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes V�;00
❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
] Yes ❑ NA ❑ NE
[:]Yes VNo
� ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes eNoo
❑NA ❑NE
Yes ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fachity Number, - Date of inspection: l `
24.Tid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g yNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes El -No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes O/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
0--No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0 No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,,❑/// ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments"(refer to question #):.Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations fuse additional eases as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
WLf
Phone D ! .� 13 2
Date: [
2/4/20l

Type of Visit: Qf CorppHance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 1� % Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: yv'�B"
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: b 3 S
Certification Number:
Longitude:
Design
Swine Capacity
W an to Finish
Current
Pap.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
can to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urgent
D P,oultry Ca aci P,o
Layers
Dry Cow
Non -Dairy
113eef Stocker
Gilts
Non -Layers
113cef Feeder
Boars
Pullets
Beef Brood Cow
O
Other
Turke s
ey Pouets
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili NumCer: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2f No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure n L Structure 3 � Structure 3 � Structure 4
Structure 5 Structure 6
Identifier: ll'V %J GA(�„TJ tJ-fYI1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement?
o
ElYesfo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[]Yes [2/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
/No
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes C3/No
❑ NA
❑ NE
0 Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes d
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
2❑
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 0X0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes UNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes F(No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Ins ection: liblill
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes o ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 9410
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes No NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LZ N~ ❑ NA
❑ NE
33. Did the Revicwer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
gNo
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional. recommendations or any other comments.
Use drawings offacilityto better explain° situations (use_additional pages':asnecessarv)�,
C C_ 5 ME to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
vP 10ATE Wd P
W u W NCI C'-gut'(rL Fn(oT IS 0 a d E
Date: b 1
4
2/4/2014

Type of Visit: is Com6liance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: / / $ County: d LCiI�✓ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: its ►�T �? %�" �� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultr3 Capacity Pop. Cattle
Layer Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current Dry Cow
D . P,oul Ca aci Pao Non -Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes FNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
Was% Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA606iic/ 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Cj No
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Lid N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[_]NA
❑ NE
20. Does the facility fail to have al] components of the CAWMP readily available? If yes, check
❑ Yes L'J No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24. 1-Rd the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes I_'J 1V ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesrNo'
o❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [—]Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes <No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes to
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.; other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: Phonet
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

(Type of Visit: (Compliance Inspection V Operation Review Q Structure Evaluation () Technical Assistance I
Reason for Visit: Routine O Complaint p Follow-up O Referral p Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: // . ��� County: a/VA 6 W Region:
Farm Name: j� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 50L_ T (yL--1 tiA(Lt'- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: I(, Z -sS-
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop. C►attle
Layer I Dairy Cow
Design Current
Capacity Pap.
Wean to Feeder
I
INon-Layer I Dairy Calf
Feeder to Finish
g� p
Da' Heifer
Farrow to Wean
Design Dry Cow
D , P.oul Ca aci P,o Non -Dairy
I Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
01
Other
Turkeys
Turkey Poults
Other
Other
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes O/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA [3 NE
❑ Yes o ❑ NA ❑ NE
[3 Yes WNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: U
Waste Collection & Treatment
4.Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes [?I/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA &vbN I LA6vW !A 44bo
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13-f 3< Zia
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes C�T/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesVNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes d/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): `
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[2"fes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
AFo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&"o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�rNo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other: 11
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -_j Date of Inspection:
f
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25• Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 12<0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 12<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EKNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
2<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ZNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
V
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
/s,) �7 � 1J66Dc39 rn--FAD
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: rnl_3 / tJ
Date: A -L--
2/4 11

Type of Visit: (0 pliance Inspection U Operation Review C) Structure Evaluation U Technical Assistance
Reason for Visit: Co7Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: fig Arrival Time: ��! S -, Departure Time: County: CK&di✓ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: _ �Q'` �t L Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
C*urrent
Design
Current
Design Current
Swine
Capacity
Pop. Wet onitry
Capacity
Pop.
Cattte Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
• Farrow to Feeder
Dr, P�oult ,
C•_a a_ ci_
Pao ,
Non -Dairy
Farrow to Finish
Layers
Bcc f Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Points
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes [
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: Q
4
Waste Collection & Treatment
4. ds storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LAGQ6ia (S C7i +7� LAG,6003
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ENo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
(o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
��No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes /No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
© No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E/� o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 Ngo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑-Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E(No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: (0 - Date of Ins ection: G o
24. Did the facilityfail to calibrate waste application equipment as re required b the permit? Yes No NA NE
PPq Y P ❑ ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []N o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes b"N. ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes 2 f NNo ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
[:]Yes [3/No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ No ❑ NA ❑ NE
zl/,�o ❑ NA ❑ NE
❑ NA ❑ NE
NNoo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better'explain situations (use additional pages -as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �b 9 C —)-3ca
Date: to
21412011

Type of Visit 6 Co pliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit e0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ENE
Arrival Time: ® Departure Time: County: 6WML41%/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: QKIerrT Aq:LfGWEL\, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [=] c [=] ' = Longitude: = ° =' =
RPgn Current
pacity Population Wet Poultry
Desi100#91Design
n Cattle Capacity
C►urrent
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
91 Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Layers
❑Non -La Non -Layers
El Pullets
❑ Turke s
❑ Turkey Points
JEI Other
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Beef Feeder
❑Beef Brood Co
Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El No ❑ NA
❑ NE
❑ Yes
❑ Yes
N ❑ NA
❑ NE
❑ Yes
L1 No ❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
t'■Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EY o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A%J i LkkwtJ -L- ACsmd -7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SO 3t~ 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L21 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes7No
o El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�
9. Does any part of the waste management system other than the waste structures require El Yes IJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q o ❑ NA
[:3 NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
6/No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
L No ❑ NA
❑ NE
Comments .(refer to:quesExplain anvYES answers�and/or any°recommendations or any other�comments
;Use°drawings of facility to'lietter explain situations (use addthonal pages as necessary)
C9.) 14V woeo,N G- ce C, G6 r cdeJU c-7 d Al6 el RC6 -ZA/ 46 66XV_r , •
r
ReviewerllnspectorName Phone: 3��
Reviewer/Inspector Signature: Date: /.
Page 2 of 3 12128104 Continued

1
Facility Number: — I Date of Inspection 1
1�
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [J No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El [I NA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes LJ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes Ld No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �i`No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes EY o ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�
[I NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
7No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
B No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
U/No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
— /
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
7No
❑ NA
❑ NE
Additional Comments and/or Drawings;
Page 3 of 3 12128104

I
Type of Visit
pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason far Visit
7RoutineQ Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ► 6 Arrival Time: 1 3 ° Departure Time: County: dN J CQl,J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 81U rXt Vra-TU ]i_[.t, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 00
❑ 1 F--T Longitude: = o = 1 ❑
11
DesiCurrent In Design Current
Swine C■apacity Population Wet Poultry C*apacity PopWatian
Design
C►attle Capacity
Current
Population
❑ an to Finish
JEJ Layer
❑ Dairy Cow
❑ an to Feeder
ILI Non -Layer I
I
Dairy Calf
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
Day Poultry
El Layers
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dai
❑ Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑ Pullets
❑ Boars
❑ Turke s
Other ❑ Turkey Poults
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E?�o ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
El NE
❑ Yes
❑ Yes
El NA
El NE
❑ Yes
Zo❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: G11— Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C14o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA 6v-6-Ai rr C46-06r/ L L.VAt ^'.3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �]
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) dNo
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VfNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L" f No ❑ NA ❑ NE
maintenance/improvement? _
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ffNNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
1, No
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
El YerNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El
❑ NA
❑ NE
Comments (refer to -question #) E_gplarn any YES answers°4R, or,'any recommendations or any o er commen
CJse drawings of fac>hty to better egplatn situations (usenadditional pages as necessary) .. ,
Reviewer/Inspector Name lJp
Reviewer/Inspector Signature: 421AII., Date: 6
Page 2 of 3 r12128104 Continued

I
Facility Number: — Z Date of Inspection i
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available?
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ 11 rF Tp ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes 2 /No ❑ NA ❑ NE
❑ Yes [f o ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E/I No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
["No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
UNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
�
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,_. No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ef(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,,��,,//
E�1No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
B No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
pJ No
❑ NA
❑ NE
Additional Comments and/or Drawings:-'
Page 3 of 3 12128104

Facility Number 1
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 6 C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up ()Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: 1 9 O b Departure Time: County: _,AhS_L 'r-J ,,, Region:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: B egt-M � C-LA_
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feedei
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o = ' = „ Longitude: = o = , "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et EEEdi
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
I'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CINo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
12128104 Continued

Facility Number: 1 — l Date of Inspection ' lb t1
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA &-,6` Z 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo
El NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes UrNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ld No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes j No ❑ NA ❑ NE
maintenance/improvement?
1. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Y s dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
LEI Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El No El NA El NE
D'No ❑ NA ElNE
Ia N9 ❑ NA ❑ NE
❑'No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1 S�� F,�Ec.os ,��GJ wE�.b Ca�lrie��- • .
Ssa wulo
Reviewer/Inspector Name
ReviewerAnspector Signature:
Phone: l'YA
Date:
12128104

Facility Number: 62 -a. j I Date of Inspection
�v Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
540
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
7N/.o❑
NA
El NE
the appropirate box. ❑ W UP El Checklists ElDesi n g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below,
El
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Weather Code
Rain Inspection�No,
22. Did the facility fail to install and maintain a rain gauge?
[I Yes❑
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
!_d N
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
iLl No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dN9
[I NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
0 NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
s.
laid[tional,>Ciimluetts;and/or Drawings
Page 3 of 3 12128104

W Division of Water Quality
Facility Number ,'Zr
L0 Division of Soil and Water Conservation
E� - — — 0 Other Agency ..
Type of Visit
Co Hance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
011outine O Complaint
O Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: I all ja�2 1 Arrival Time: ® Departure Time: County: 049-AA) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
On site Representative: Zakk 1- " W s.T-
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 = Longitude: = ° =,
=
Design Current Design Current
Capacity Population'. Wet Poultry Capacity Population Cattle
1 ❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
$6
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
''Other
�', ❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
esrgn, Currents,:,
pacity Population
El Dairy Cow
ElDai Calf
El Dairy Heifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of 5thlctures �,'` °
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ff No ❑ NA ❑ NE
El Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
El NE
El0 Yes
,_,<0
No
❑ NA
❑ NE
12128104 Continued

:acility Number: (� —(
Date of Inspection
Waste Collection & Treatment
/No
�r 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LAC1-c7)J LAGyXW 2 _t_-A&-vull3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 ate% 43
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E;k<o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
94❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
�
El No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[? N ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
7No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
�No
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or'aay ottier_ comments
Use drawings of facility to better explain situations.. (use additional,pages as necessary,.):,
Reviewer/Inspector Name __o_14d 12A f Phone: %0)
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: {j'� — Date of Inspection`s
' Rectuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2< ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2<O ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [? No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections E] Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CI No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E N ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[/a
El NA
El NE
El Yes
(: o
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes ,EP,<o El NA ❑ NE
ElEi Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes pvo ❑ NA ❑ NE
❑ Yes L i�o ❑ NA ❑ NE
❑ Yes L2 No ❑ NA ❑ NE
Page 3 of 3 12128104

FadUty'Number 6,7
Division of Water Quality'
0 Division of Soil and Water Conservation
0 Other Agency'
E
f Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit tJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: y,r Departure Time: County: 0AISV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: &6vl. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: �0 0 ' 0 Longitude: = o
Design Current Design UGurrent - _alDesign= �s}Cnrrent-
Swrne.� Capncfty 'Population ' :Wet Poultry Capacity Population' . Cattle Capacity Populatron
Wean to Finish ! JE1 Laver
Wean to Feeder
L❑ Non -Layer
Feeder to Finish
Irm
Farrow to Wean
Dry Poultry
Farrow to Feeder
` ❑ La ers
Farrow to Finish
LJ Boars l
Other
❑ Other
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood Co
=C Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3.. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes JI�No El NA ❑ NE
El Yes 4Ef No ❑ NA ❑ NE
12128104 Continued

Facility Number: �p —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: /A&- w J Z LA(smae/ 3
Spillway?:
Designed Freeboard (in): gky
Observed Freeboard (in): �J 3 3 q3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
Structure 5 Structure 6
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,..,�
9. Does any part of the waste management system other than the waste structures require El Yes C! No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) E/�EnW* IY�}�
13. Soil type(s) A oz 04r✓fA 14t, c_A &,, !/mtai a Jrm C.1-rli,/&_-r
14. Do the receiving crops differ from those designated in the CAWMP? El�I Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes [I No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes L/ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes n 'No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes L`J No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendatiops or: any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1S'� F c.dS iVEEp Lrm-£ AM) y✓E6b C.�77taL.
Reviewer/Inspector Name L j� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 !" 12128104 Continued

Facility Number: — Date of Inspection b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑-1VO ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
fJ No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[I Yes
,2,
L�l 0 ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E oo ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Cl Yes
(_y' o_ ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
U<o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2ZNo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Q( C pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 7Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: O T AL CA U 060619
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Owner Email:
Phone:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
�o
Latitude.
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other - - - - - ----
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
urkey Poults
❑ Other
Discharses & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: =
0
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dair Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
NA
ElNE
❑ Yes
o❑
El Yes
WNo
ElNA
ElNE
❑ Yes
LdNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection b LoS
r I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: M2-1 MR.2 MIZ_3
Spillway?:
Designed Freeboard (in): 7-0 Z-0 20
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
,� ,/
❑ Yes LQNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tllreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes �No El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes LI N El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C:fI N► dA ( A l 54,6
13. Soil type(s) - A Lrrn_Y✓.LuLJc_-_ _.•.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�.I NNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`s
❑ Yes
O6 N ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
rNo❑ NA
❑ NE
+IAOST 00 aA)SPt=C_r1:orJ ---C L#NG,0DrJ 1.-�At
J?DATE r_ Z-ov `eZ:k_4_e lr ar_4V 1 ,
�f4fUrY` rvvYA' P-J-T- A-r-�'fD- I
f ax-__v-oJr 0 N
Reviewer/Inspector Name s };� A; ir{ .... ` .. }}. °'�j Phone: 39S`' g6ax22
Reviewer/Inspector Signature: Date: 4 G DS
12128104 Condnued

Facility Number: `� — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EJN(,v ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. IJ Yes ❑ No ❑ NA ❑ NE
ly Freeboard ❑ Waste Analysis ❑ Soil alysis ❑ Waste Transfers ❑ Annual Certification
❑ Waste Application ❑ YcropYield
El ElStocking
Rainfall ❑ 120 Minute inspections Monthly and 1"
Rain Inspections
❑
�
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� o
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElFNo
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
Z
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

el
IType of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Id Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name. ........... !./..l ..._..�,L"r^'� _....... - ......._......._.. - ............._...
Owner Name
Time:
berational O Below
Date Last Operated or Above Threshold: .........................
County: ...... OrL' ��' � ..........�... ...._ ....W.
Phone No: ........... _. ...... .........
MailingAddress: ....... ........................... .............. ..._......._............... .................. ...... ................ ......................................
Facility Contact: ................. ..................... ..... ...... ......... ...... ......... --- Title: _. Phone No: _. ...... - .- .....
Onsite Representative:.� " "�L ' " `' Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
m Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 66 Longitude • 4 44
` Desigiu Current Desagn " Cut real Desgn = Currt
Ca a uiation '= `--. Ca T ci Cattle ; Ca ' Po iilation
�l?o
�:Po`WaEranr _. .
=- Ij Wean to Feeder.
u ❑ Layer 0 Dairy
Eff Feeder to Finish
❑Non -Layer ❑ Non -Dairy
- Farrow to Wean
_ p r
Farrow to Feeder
_ Other Y E: ,
Farrow to Finish
� _.,`�'�
Total Design Capacity
�r��
llllt$
Boars
as ` SSLW
x
Discbarses & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes Jd No
[:]Yes [:]No
❑ Yes . ❑ No
❑ Yes ❑ No
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes Rf No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Cl Yes 01<l0
Structure 1 Structure 2 Structure S Structure 4 Structure 5 Structure 6
Identifier: ..... /............... _..O ..... _ . -. *�......._...-- _.... ................... ----... ................................--- - ..._._............. ...........
f
Frecboard (inches): 3
12112103 Continued

Facility Number: — Date of Inspection] p
5. Are there any immediate threats to the integrity of any of the structures observed? (iee//'trees, severe erosion, ❑ Yes j2fNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Z No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 16 No
8. Does any part of the waste management system other than waste structures require maintenance) mprovement? ❑ Yes 19 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
0 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ZNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
ONo
Hydraulic Overload ❑ Fryzen Ground qCopper and/or Zinc
[]Excessive Ponding ❑ PAN P..
12. Crop type �j, pv
13. Do the receiving crops differ with those desi ed in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
,1 No
14, a) Does the facility lack adequate acreage for land application.
�� C/C�
❑ Yes
J'No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
J2TYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
,KNo
Odor bsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
JeNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
O'No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
7No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
XNo
Air Quality representative immediately.
`Use; W-wrngs aar tacwtyto better exptarn sttauons:tnse aamttonsipags ' Field Co
❑ Fea,necessary
lJ�"� �tlL4S 11 kv-0
�%�O �O�✓r�2o� 1✓��<_' o `2r,� ®r.���C /�2��c o 5 �o JPa U
�i'ff/e CT RN✓S ES �Z�GO S /�% /Y�� ✓Ei�� F 1 �Om / &""9
A-4 �v zC- 5� iQF,00 er /T F_Camn��NU�® G��nF 60�/' �d -
©,e /7?,sfL��
"�A'5 OK.
Reviewer/Inspector Name TP
Reviewer/Inspector Signature:
Date:
12112103 Continued

+ Facility Number: Date of Inspection SL /21 /pS¢
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ )VUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
❑ Yes ANo
❑ Yes ONo
Oyes ❑ No
❑ Yes Rf No
❑ Yes [' No
❑ Yes 0 No
❑ Yes ZNo
❑ Yes ONO
❑ Yes ZrNo
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Rf Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gNo
32,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2TNo
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
ONO
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
Z No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
zYes
❑ No
❑ Stocking Form .RTCrop Yield Form ❑ Rainfall ❑ Inspection After i" Rain
,0120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddiUtE)nal COitIrCleniS aI1diL�`'DrdWingS _ =
Z 3) - G��a�a. 305 ✓"wlem r'0'9 G�P G�Ts2
- Akia &/3 s re 41Vq4,V S.ZS /11'
1�E0E,D �M &)ASTE AOX71-�r-4T�
Alcrxx 3/2,0lfl-/-,
l wg_Zs /V - 015
o A)or
3/fi
,55) I06Fa 76- Glsea ZAR -I
P"5 R, �T CRnP i?je coed�-
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Date of Visit: 1,5 2 Time: I
Facility Number
Not Oiperational 0 Below Threshold
0 Permitted ❑ Certified 0 Conditionally Certified © Registered Hate Last Operated or Above 'Threshold:
Farm Name: M R to o G5 _ County: Ori6t— rO U)
Owner Name: Rk_S_Rol AN A U l i- A Phone No:
Mailing Address.
Facility Contact: Title: Phone No:
Onsite Representative: �F 2 m
. _n3T I 1 ` - C4-F_1 ' Integrator: e>Q RQ
Certified Operator: Operator Certification Number:
Location of Farm:
ASwine ❑ Poultry ❑ Cattle ❑ Horse Latitude a • u Longitude Da 0
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes PrNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed_ was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes. notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;xNo
Stpucture I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: tt Z J?
fL
Freeboard (inches): 12 34 3
05103101 Continued

Facility Number: — 21 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed!?. (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
ONo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
A
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
((No
11. Is there evidence of over application? ❑ Excessive Ponding PAN ❑ ydraulic Overloa
❑ Yes
0 No
12. Crop type kj , lsi2 (� ti E
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VfNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RrNo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
A Yes
ElNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Ree uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
ElYes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
to, No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Nail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
�Z(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer_to;giiestton #): Explai© any I'1~S answersandloi:anv rommeadahoos:©r sov other comments,, -
_
Use drawings of facility to betteir explaigsituations.:(use addidonal:pages as aeees ryj ❑ Field Coav ❑Final Notes
15 Q�cK kEk)MUoa F�zF_t_0 ' rEOs MORE, �nPRo�EmE,�T.
�ERm� DA APPERRS i o (a(�s�} i�OR� �a l Win} cjo
s. S rnP'Lc-V-(� zn1
�P�F R S c� ©mzrJc- p �a So �
Reviewer/Inspector Name QjB
Reviewer/Inspector Signature: Date: II 5,
05103101 Continued

Facility Number: Date of Inspection
dot- Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt. ❑ Yes No
roads, building structure; and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes O'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? El Yes `/— No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes No
Additional omments an or= raw:ngs: _ =
1 C
15�50�� l r s7 a~Porz� r o2
QFGLp-spfMF,,)-rS -gF LO LO l 7-&3 /OCOF
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PF-�-20MYN.F-00 DOCQfy\F-QTT-('JG- NL-c ( NA-
M PQo 0 F SftF-;� EIS. SLID4 65 Lz'm G
s
S_"PEEP
L5 1 4r so-zz—
Ctt
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LA 3 T 4-� LOWF2 PN17 F- ���C H Wflu� �E
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2 5 f ac o 2 b cz�A -,- c \DU&Ppr �+E
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tVrr , �i�FQ�/
O5103101

t)ate of Visit: �l—Q Time: © Printed on. 7/21/2000
Facility Number �.
Q Not O erational Q Below Threshold
Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: .. (�......................................................
!'.T.1................................................................................................ County• ay."AGL?
OwnerName........................................................................ Phone No:.......................................................................................
Facility Contact: ... Title: Phone No:
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative: -. .. \1�Integratore .............
................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ 5wlne ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 °t Longitude ' 6 44
Desi Current Deli Current Deli
SA.. Design .. • 8n Cnri ent
Swipe
:.-,,:: Ca aci . ,Po ulatiun Poultry Ca ci . Po ulation Cattle Ca Po tioiti
Wean to Feeder ❑ Layer PO
Dairy
Feeder to Finish n(x ❑ Non -Layer Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other
_- Farrow to Finish Total Desi Ca
Pa tY
Gilts -
Boars ToW SSLW •.
N�auber of:I.agoons ❑ Subsurface Drains Present Lag�n Area ❑ Spray Field Area
Holding Pands !Solid Traps ❑ No Liquid Waste Management System s
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
. ❑Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estiiwled flow in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M No
Waste Collection & "Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O'No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5/00 Continued on back

Facility Number: Ok -*'�� Date of Inspection Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management of
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
10/26/2000
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes VNo
❑ Yes 0 No
❑ Yes XNo
❑ Yes Ef No
❑ Yes tff No
❑ Yes El No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type Ve '- s\ �� d�R 2 2
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No'
14. a) Does the facility lack adequate acreage for land application? ❑ Yes O No
b) Does the facility need a wettable acre determination? ❑ Yes ZNo
c) This facility is pended for a wettable acre determination? ❑ Yes O No
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes 4 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
)�'No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KfNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
10 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
W'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes WNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes VNo
24. Does facility require a follow-up visit by same agency? ❑ Yes J No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes j No
�'�io yiol;aiicjris or tlef cietic{es mere noted diii ing fhis;visit: Y:ot It eeeipe Rio further;
;corresnoride... aboutt: this visit......... .:::. ::.:.......::: .
:Coinments (refer to question,#): Explain any. YES answers and/or any recommendations or any other comments.:
Use drawings of facility to better explain situations. (use additional pages as necessary)_ =
���. rtt .f �, c►._.zt1 ,_,[[ -tee-. -eye►—�.ee�
4r,00
`D�sk� -�,��� sl.-•�,�� fie. �w=� �r
Reviewer/Inspector Name
Reviewer/Inspector Signature: � _ ( q ��_ Date: 5100

Fac ity Number: 67 —a Date of Inspection L G ( Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 4 No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes �3 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
i
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
j No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
, No
Additionornmeuts.and/or _raw4ngs:
��� �r-��--r�- �c'�..�� � �,p�C��� G� � tee► -.seed G� (��f � '� l lr--�t �
v�-yes cA �� -Vt "-Q
U
5100
J

a�

Division of Water Quality
Q ivision of Soil and Water Conservation
tD Other Agency
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit �Ylr\ outine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Thne: �a Printed on: 7/21/2000
Q Not Operational Q Below Threshold
RPerimitted ❑ Certified © Conditionally Certified © Registered Date Last Operated or l bove Threshold: .......................
FarmName: ...(..t.................................................................. ............ Count y:...................-'............................ ......................
OwnerName: ................................................... ........................................................................ Phone No:
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: .................................................................................................................. ..................................
Onsite Representative: , -,`� �...... ,....., „-_. Integrator:... � �cti
Certified Operator:,,,,,,,, ..... ..---.... Operator Certification Number:
................................................................
Location of Farm:
rIq
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �� Longitude �• �� �
Design Current
Swine Canacitv Panulatinn
❑ Wean to Feeder
Feeder to Finish
19TOO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
IEEE]
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacitv Population
❑ Layer JE1 Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag -on Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made'! ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) [j yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/rnin"?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes b�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes ,N' No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 'N No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............................................................................................................................................................
Frechoard (inches): �� 37 ` o
5100 Continued on back

7
0

Facil* Number: -- r5.Date of Inspection Printed on: 7/2112000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge`?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Vo-*Wo ti6is;oi- deficiencies were hued during this:visit; Yoi� wiil reeeiye Rio further -: •
. - . ' corresporideitce. about this visit. ' . .. . ' . . ' . '
❑ Yes XNo
❑ Yes ONO
❑ Yes XNo
❑ Yes 1�eNo
❑ Yes 'M�No
❑ Yes D'No
❑ Yes XNo
❑ Yes DE(No
❑ Yes N'No
❑ Yes ❑ No
❑ Yes ❑ No
9Yes ❑ No
❑ Yes gNo
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�a t-� vk-- k�4 6 r� va ��--.tie►--
❑ Yes KNo
❑ Yes ONO
El Yes WNo
❑ Yes 4 No
❑ Yes Im No
❑ Yes No
❑ Yes KNo
❑ Yes " No
❑ Yes ONO
Reviewer/Inspector Name��
tr�—�-.��..
Reviewer/Inspector Signature Date: � Imo_ 5100

+� F0611ity Number: Date of tuspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below [KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes INo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes . r�No
Additional Comments and/orDrawings:
5/00

a
r{
:'
'
r
i
.,
�.
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1
FFacility Number 2 Date of Inspection S C
Time of Inspection Z S 24 hr. (hh:mm)
Permitted 13 Certified 0 Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
FarmName: �' 1•I. o S Count 4...............I..........................................
Owner Name:......... mrr,r 1�,,,,,,, ✓�'t vc Phone No:
................ �t................................ ............
Facility Contact: .. Title: Phone No:
MailingAddress.................................................................................................... ...................................................................................................... ..........................
OnsiEe Representative: 4/ �`✓a �J..J...ScYt G'....... Integrator:......11
..........................................................................
Certified Operator:............................................................................................I................... Operator Certification Number:..........................................
Location of Farm:
Latitude =• =' =11 Longitude =• ' 14
} Desrgn Current Destgn CFtir
Swine
;Capacrty ��Popiilation :` . Poultiy . Capacity :Poptil
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Non -Layer
❑Other
r:
-T.6til
�Number�of Lagoons , -= 3 �: ❑ Subsurface Drains Present
'Holding Ponds,/.Solid Traps ., ' ❑ No Liquid Waste Managen
segn =Current
iacity `i Population
Lagoon Area. ❑ Spray Field Area
System
Discharges & Stream•Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than.from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: u1 Z 3
Freeboard(inches): ..........,1............................2..4..................... ..... .................................... ..................................... ... ............... I.................
5. Are there any immediate, threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Fv�Ity Number: — Z Vate of laspection Z2 oe
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Anolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21 _
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Ye"s
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0: -io *violations oi- &fidenues were noted. OiWifid this: visit: - :Y:oWwill-receive rio Ourth . .
,corres� ori�ence: a�outk this :visit. • :.....::::::... .
Gomments.(refer -to question #): Explain any YF.S'answers and/or any recoinmendattons'or auy othercoinments
_.
Use drawings of factli *10 better. explain Si (use additional.pages.as necessary)
-T_►?5'rcC4ioi't 014- e? n' ► _,.41
n Ae Net,,j! 47,1e Fr, u.t4 Ai o e v' fence n/ Lj✓ _r7A_ 'W
'7. ��" e�� ,' •- /> / i � 1 y don -�a ne Ve n
G(G ^1 c, q�' 40 ��'�e LJd1l / .
116
3/23199

Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION[
Facility Number Operation is flagged for a wettable
Farm Name: K,7 c __ acre determination due to failure of
On -Site Representativ : Part H eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name:
_tv��
Date of site visit: h9.
Cate of most recent WUP:�'
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Anndal farm PAN deficit: l " pounds
hard -hose traveler, 2. center -pivot system; 3. linear --move system;
Irrigation System,(s) - circle <5
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part II; overrides Part 1 exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D j and DJD3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11- F1 F2 F3, before, completing computational table in Part 111).
PART If. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
.requirements listed below:
F__7 . Lack of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
_2
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA detemyination required because CAWMP credits field(s)'s acreage in excess
_ I— _ of 75% of the respective field's total acreage as noted in table in Part 111.

Rcviscd January 22, 15
Facility Number -_
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER'S
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
r�
�0
y4
li 13
q
�. 1
g*�
0,6
too
90L4
�-
it
�o
g,9
FIELD NUMBER'
- hydrant, pull zone, or point numbers may be used in place of field numbers
depending on CAWMP
and type of irrigation system. If pulls, etc. cross more than one meld, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBER' - must be clearly delineated on map.
COMMENTS3 - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

Rcrised January 22, 1995
;JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number �r] - -x Operation is flagged fora wettable
Farm Name:K-� P , zG �21 acre determination due to failure of
On -Site Representative: r-�e, Ct, Part 11 eligibility items) F7 F2 F3 F4
Inspector/Reviewer's Name:
Date of site visit: e,;Okdqc�
Date of most recent WUP: ia- G(9
./ Operation not required to secure WA
determination at this time based on
exemption E1 E2 (3 E4
Annual farm PAN deficit: -:)-9'3-0 pounds
Irrigation System(s) - circle to hard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acresjs complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
/ depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11- F1 F2 F3, before, completing computational table in Part 111).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 track of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
bufferlsetback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised January 22, 19!
Facility Number -
Part 111. Field by Field Determination of 75% Exemption Rule for WA Determination
FIELD NUMBER' - hydrant, pull, zone, or point numbers may be used in place of field numbers depending on CAWIOP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBERZ - must be clearly delineated on map.
COMMENTS= - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

*- , 4L-i I
Lagoon Dike Inspection Report
Name ofFarm/fraciIity
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:1 V
Embankment SIiding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
�0 `T Names of Inspectors i Q/I Pi
�L,7
/ Freeboard, Feet , 7i
Top Width, Feet
2 *D / Downstream Slope, xH:1V _
Yes I"— No
Yes No
Yes )0 No
` I
F A
Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes ^ No
Engineering Study Needed? Yes_ No
Is Darn Jurisdictional to the Dam Safety Law of 1467?
Other Comments
Yes - No

w4
Lagoon Dike Inspection Report 7�
Name of Farm/Facility
Location ofFarm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
.(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Names of Inspectors
T%-
Freeboard, Feet
y(n K To Width, Feet
0 —
-2— ILO Downstream Slope, xH:1V 1
Yes No
Yes No
Yes I No
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes _ No
Other Comments

Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Lagoon Dike Inspection Report Z �.
5_4
Names of Inspectors
Structural Height, Feet �� }� �_ 7 s _. Freeboard, Feet 37
Lagoon Surface Area, Acres Top Width, Feet t! b
Upstream S1ope,xH:1V / Downstream Slope, xH:1V
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of V_ P r (-p 6 o r�
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes \x/, No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments f7u,1!5q, A5 ­_.P „ "
1
01

13
Dtviston of Soil and Water Conservation Operation
' Q Division of Soil and Water Conservation -Compliance Inspection
`Division of Water Quality, Compliance Inspection -
© Other Agency - Operation Review
0 Routine Q Complaint Q Follow -tip of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number
Permitted © Certified [3 Conditionally Certified 0 Registered
Farm Name: .......'.`.....
Owner Name: -.-.
Facility Contact: .................. .......... Title:...................
Date of inspection
Time of inspection Qd 24 hr. (hh:mm)
0 Not OperationalOperationaij Date Last Operated:
... County: .....�{.............................
Phone No:a...!..at.Q.J........
Phone No: 9�p-33..0�.Oot�.+ tV
MailingAddress. ..................................................... .................................................................................... ..........................
Onsite . . . . . . i"Ll into;rator:..................................................................
.
Certified Operator:................................................................................................................ Operator Certification Number -
Latitude 0 6 C Longitude 0 C 44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ soars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance ntnn-made?
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If dischark,e is observed. what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure
Identifier:
Freeboard (inches): .......... ...............
Structure 2 Structure 3 Structure 4 Structure 5
............. ........... ................ .................................... --.......
❑ Yes Z No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes NfNo
❑ Yes N(No
i
❑ Yes J�,fNo
Structure 6
116/99 Continued on back

Facili!y Number: --,'-, I Date of inspection
". "Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.}
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application'? ❑ Ponding ❑ Nitrogen
12. Crop type .... ............,... .Sr�........... ...._................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewtinspection with on -site representative?
24_ Does facility require a follow-up visit by same agency'?
]: N.o.vialati'ons or. defici'encie's 'w'ere noted. dviring Ais:visit . Yoti wilfre�ceive nu further ...:
cgrrespgridenee'AiA1fthis visit........... .;•;•;-;•;•;•:•;•;•;•;•;•;•;•: :.:.:.
..........................................................
fer to question #): Explain any YES answers aud/dr any arecommendations or any outer eoinmen&
of facility to better explairfsituations. (use additional pages as necessary)
❑ Yes bdNo
❑ Yes KNo
❑ Yes
ZNo
❑ Yes
NrNo
❑ Yes
0 No
❑ Yes
NfNo
❑ Yes
WNo
❑ Yes
9No
❑ Yes
�d No
❑ Yes
9No
❑ Yes
�10
❑ Yes KNo
❑ Yes Nf No
❑ Yes 9No
❑ Yes W No
❑ Yes MNo
❑ Yes [gNo
❑ Yes VNo
❑ Yes No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
q
Date: _�Q l 1 11/6/99

4 1 .
w

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
TQ Routine O Comolaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other 1
Date of Inspection /D ,2,
r I Facility Number a21
Time of Inspection �lJ 24 hr. (hh:mm)
ei Registered Wertified 0 Applied for Permit Permitted 0 Not Operational Date Last Operated:
Farm Name:....{;,h'....CflY�N.Il��.!�}/...�`C County:..........U.JUSLotcl. .....
Owner Name:.. jlr A.04 .......... CA V1.4 U ............................ Phone No: ...... 3-,36..-.. ..Z.Q t ..... l..o L�� ........ ............
/l9 /�-� p Gt1 a1 ��
FacilityContact: ...................................... .....U....................... Title:.--.- tt)--..........................---..................... Phone No:.. .~.......
8 t LAW D-S � C of k 5 7 V
,p F �
MailingAddress:.h..:. .r..e?�l%..... �1.. �............ A ................... ........./ ,, r ................................................................................. ..........................
Onsite Representatives... il!V19 yNC7....... 1�0 .^'................................... Integrator:....C4..Gb„ (1�Q...................-----...
Certified Operator ,..... A17t<K........
Location of Farm:
Operator Certification Number ,...... &a2.a..J5...........
I&
............. -..................... -----..................................... ---............................................................................................................................................................................................
o r.... o 1. t�. w .....B NB ...... ......... ..... � �.�...W....:...F .... �....................
Latitude 0 9 46 Longitude • ©6 "
❑ Layer
❑ Dairy
❑ Non -Layer
I
I
1�;❑
Non-Dairy
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes N1 No
2. Is any discharge observed from any part of the operation? ❑ Yes 14'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is obsen-ed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system`? Of yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes �No
5. Does any part of the waste management system (other than lagoonsfholding ponds) require ❑ Yes OrNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

I
i �
Facility Number: 612 — �7?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding, Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier: -# / _e Z -� 3
Freeboard(tt):........ `.3:..............................`7.-.....1........................a............................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
❑ Yes JkNo
❑ Yes ❑ No
Structure 5 - Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
o.violations_or d6rciencies. were: noted -during this:visit:, You:will i-eceive, nostiril�ei� 7
�::-correspondenceatiou�tttis:visit.•::�...•:�:•:�•:�:�::: ...•�-.�; :.�.��:�.-��::�:�;-::�..�
r,4,em t-,wee,,- Gaat, — wcc_�_ eL)^J
❑ Yes ONo
❑ Yes kNo
❑ Yes ANo
❑ Yes �No
❑ Yes ;4No
❑ Yes EN(No
❑ Yes 'allo
❑ Yes Q ' 0
❑ Yes 1 \\No
❑ Yes JXNo
❑ Yes No
❑ Yes ANo
❑ Yes ,kNO
❑ Yes A(No
❑ Yes )<No
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: Dater l�% 9

ElDSWC Animal Feedlot Operation Review,
,Q� DWQ Animal Feedlot Operation Site Inspection`
���_ ��; *."e . w.h�. �' . m.,�_...�w ..: .0 , ���_ _ : ..-. , >-: �... ,�_ � •�„-, .�,�..�. - : «, mob- ,� , � � � r'
r
® Routine O Complaint O Follow-up of DWO inspection O Follow-up of DMVC review O Other
Facility Number Date of IInspection
Time of Inspection '�ij� 24 hr. (hh:mm)
© Registered JR Certified [Applied for Permit JMPermitted 113Not Operational Date Last Operated:.....
Farm Name:.......M ..... Q.......... 04.�.. County: �Yl.�tll............................................
Owner Name:....., fir. - .................... - R 1/� /�/4 C1(a F� Phone \'o:.... ..... 2 �Y............................................................................I..................... ...
Facility Contact:..o ....................................43d -�.............l�........... Title:..�il9ailing Address: F �i� G L/i,/vs 3 p �Z 7ti
�.x...........�.............................................................................1�....................................... ..A?-..........
Onsite Representative: ..... rVu+04 ............ 6,0.4v,&7UjAV.4! j?. ......... Integrator:...... v.. `. .. {-C1.-... 7
Certified Operator,..... . �... --------------------C'/y,)/,fyn/„ft Operator Certification Number:./&..Z.....5...-........
Location of Farm:
Latitude "�• 0' " Longitude • ' 44
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
W
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
c
Design Current Design. Current
Poultry Capacity- Population Cattle Capacity.. Population . -
❑ Layer - ❑ Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other 1 17771-
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds' ID Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes EMO
2. Is any discharge observed from any part of the operation? ❑ Yes EgNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q'No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes BNo
c. If discharge is observed, what is the estimated flow in al/min?
(1, Does discharge bypass a lagoon system'? (if yes, notify DWQ)
❑Yes
�a
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
�o
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[�[No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
Q-Ko
maintenance/improvement?
6. Is facility not incompliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[ o
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[9" lG
7/25/97
Continued on back

Facility Number: — Z
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes EKO
Structures (La2oons,llolding Ponds Flush Pits etc.
9. is storage capacity (freeboard.plus storm storage) less than adequate? ❑ Yes B"No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................... .......................................................................................................................................................................................................
Freeboard (ft): .......�,....�............ .......�•.................3+�.��..................................................................
............................................................................
10. Is seepage observed from any of the structures? ❑ Yes [3-No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. 1s there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ......... .................c.........................�� �.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes Q-Nb
❑ Yes GI -No
❑ Yes U-No
❑ Yes RNo
.................................................
❑ Yes
❑ Yeses
_E991FO
L►d' O
L� Y es
❑ No
❑ Yes
[3-Ko
❑ Yes
9<0
❑ Yes
UKO
Cl Yes
F'No—
0 No.violations or. deficiencies. were noted during this.visit.:You .'will receive -no further
corresoondeha Ah'out this. visit:
❑ Yes �o
❑ Yes B<o
❑ Yes (]<To
1 to ,gq/Grr/A vjjt/ WV 3's—, lZ f clis fla& 4's 671AL-j 'rw ¢jGcr�c�iY7= �'v tom.
br, A ,c-3 'rV C t ovz_ � f; (� P � t c ,�t , o�J >�q S cam, S -C s .
7/25/97
Reviewer/Inspector Name
[Reviewer/Inspector Signature:
Date:

Site Requires Immediate Attention:
Facility No. L if- — Z!
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �Z , 1995
�11 Time: 3 ;ao
Farm Name/Owner:
Mailing Address: 0, 60X 3 � .lam � '�_. o?, 5 7V
County:
Integrator: S19 IkI11/11_4Z Phone:
On Site Representative: _� /_� Phone:
/� /s;
Physical Address/Location: �.". - -- le-e 712
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
3saa
DEM Certification,Number: ACE DEM Certification Number: ACNEW
�S ' A/?' Longitude: 7 ° 9 7 ' ,01 Ao" Elevation: `��! Feet Latitude: 3
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)/ Ror No Actual Freeboard: =Ft. _/ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or 'o
Is adequate land available for sprays es r No Is the cover crop adequate? Yes o No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?<& or No
100 Feet from Wells? 'des or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or N,
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: /tom Gam- A-�
i �s
Inspector Naine
Signature
cc: Facility Assessment Unit
- Use Attachments if Needed.

OPERATIONS BRANCH - W0 Fax:[phone] Jul 24 '95 18:09 - P.18/18
Site Requires Immediate Attention _A14)
Facility Number: a 7-
SITE VISITATION RECORD
DATE: 7uzy . s— , 1995 jU,j
Owner: /''J.4X.e• C'Av.AvcN _ Farm Name: M . '' ads
County- avr 4 OcJ
Agent Visiting Site: A oe r -- .�. Phone: (.Tl—o1 , r-�•=may;
Operator: _ r�r.9.cf'_ L' :4v.� .� u �1f! - _ Phone: LF/0 gd !y • ,?,rvr
On Site Representative: ".4^i Phone:
Physical Address: w r dzsfKr0-0 t f o .,- 4 -cw�r
Mailing Address:
0,u r+i
Type of Operation: Swine c.�" Poultry Cattle
Design Capacity: Lrr v e.a . Number of Animals on Site: _ 2 {.rQ
Latitude: � " Longitude: "
Type of Inspection: Ground _ A-� Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot+8 inches) or No Actual Freeboard: _.^A Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes ord Vas there erosion of the dam?: Yes or6p
Is adequate land available for land application? Yes ordps the cover crop adequate? Yes o No
Additional Conunents: _Pe ZAGve&:4. /-,00!�i[y.�.�=.�.y: r�� ,(.��oo..+ V',- 'ev.9i
��[/� _ �r o,i.C� �,.��C �c/rry��.r CpvF_.ti CsY✓�+ /u /3�_ _
LA�,.%i :� a .t•r�Avry i �/�,r i=i9�[ P Lcrs �.ir �.
Fax to [phone] SiL- azure of

OPEPHTID-IS BRHNCH - WQ Fax : [phone]u48 Ju 1 24 ' 91, 1.3 : 1_1,a P. 18/1
Site Requires Immediate Attention Ava
• Faci3ity Number: a 7
SITE VISITATION RECORD tr,'
DATE: 1995 Jl�i
•
Owner: /14,9.5 C'Av, cr i Farm Name: M • _' %!p3
County:
Agent Visiting Site: Ivs r Phone: r1#1-- yy7z
Operator: Ate/_' L' Av.a.W. u `,f/ Phone: (yz, 1 ,1�t y - . `vf
On Site Representative:Phone:
Physical Address: 44- Oezd .., o.- ,rj * . 0~ A£a,vi
Mailing Address:
e
Type of Operation: Swine �!` Poultry Cattle
Design Capacity: L.LL o e4 . Number of Animals on Site: , w_ %•r.._�
Latitude: _ _ ___° Longitude: "
Type of inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot f 25 year 24 hour storm event
(approximately I Foot f & inches) or No Actual Freeboard: T�2 Feet Inches
For facilities with more than one lagoon, please address the other lagoons` freeboard under the
comments section.
Was any seepage observed from the lagoons)? Yes or vas there erosion of the darn?: Yes or6]o
Is adequate land available for land application? Yes orIs the cover crop adequate? Yes o No
Additional Comments: �/lGc�-�dEt u.�.�.9. 1'•^� „.¢�'oo..• .4�r'?�
73
L.4.,,!� :1 D ,rr•�.o • a.v i ���:,r r=�9lc � �i .r,�� s� -
Fax to [phone]
Si-rr:i!ure of A

Site Requires Immediate Attention: ry v
14- Facility No. - Z Z-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Z , 1995
Time: 3
Farm Name/Owner: M d /1'I 2 /_/ol .s Itf A,e✓G
Mailing Address:
County:
Integrator: ( 2 %S VIo.-o
i/
���
Phone:
On Site Representative: V�.�L
0,4yc n a,_._X
Phone: 6tS-
Physical Address/Location:
Rf &-k,
41ca -
&
Type of Operation: Swine
✓
Poultry .
Cattle
Design Capacity:
Number of Animals on Site:
DEM Certification Number:
ACE
DEM Certification Number: ACNEW
Latitude:
Longitude: 7 7 °
3 7, �% �' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm -event
(approximately 1 Foot + 7 inches) Zgbr No Actual Freeboard: __5 _Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes o No as any erosion observed? Yes or'No
Is adequate land available for spray? Ye r No Is the cover crop adequate? Yes o 'No
'Crop(s) being utilized: 1, 5/ /1 9 12.9an S - rW_9d Ad Cd✓�-�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(5 or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS-Blue Line Stream? Yes or Vo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(No If Yes, Please Explain.
Does'the facility maintain adequate waste management records (volumes of manure, land applied,
spray.irrigated on specific acreage with cover crop)? Yes 06
/ - r
Additional Comments:=e
-Al iP _ /Bad !1 �6[ �� Y ��-n-- c /��_, S✓�,.,a .
Z.Z�/s
Inspector NarAe
M
Signature
cc: Facility Assessment Unit
41
Use Attachments if Needed.